I also suspect, as you suggest, that the trichodynia is a result of rapid hair loss. I share your frustrations with how very little we dermatologists know on the subject. The only observational study on Trichodynia and chronic telogen effluvium involved only 8 patients. Only one of those eight went on to have androgenetic, permanent hair loss. The numbers followed is pathetic!
Hi Celest, My name is Sheena. I’m from a town right past Sugarland. I need to see an endocrinologist, as well, then because my dermatologist has changed my medicine three times, and my hair falls out in huge amounts every day. He diagnosed me with androgenetic alopecia, even though I told him SEVERAL times no one in my family on either side is bald or going bald. If you find a good endocrinologist, please share the name with me. Thank you

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I have used Rogaine (5% – the real risk is if your pregnant, or trying to get pregnant. I didn’t think there was a point to taking “women” rogaine which is a 2% solution). You can buy this in sam’s club with no prescription. I think it may have caused some stabilization but it was hard for me to use it because it would make my hair oily and the thinning would appear worse. So I use it randomly and not twice a day as it should be used.

When healthy hair is pulled out, at most a few should come out, and ripped hair should not be distributed evenly across the tugged portion of the scalp. In cases of alopecia areata, hair will tend to pull out more easily along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy.[11]
Eva if you can look at some of Pilar’s post she mentions in one of them a dr she sees in NYC. She loves her and the dr has done a lot for her. I would say there is no doubt it is the Retin A that has caused your loss, but it is probably Telogen Efflivium which is temporary and the recovery is nothing like they say it is. Especially if your scalp is miserable because there is a lot of inflammation that will need to calm down before everything can reset itself. Please try to find her post where she list the derm she sees. She loves her.

Spironolactone, an aldosterone antagonist with antiandrogenic effects, works well as a treatment for hirsutism and may slow hair loss in women with AGA, but it does not stimulate hair regrowth. Estrogen may help to maintain hair status in women with AGA, but it also does not help with regrowth. Few controlled studies have examined the many non–FDA-approved hair growth agents such as cyproterone acetate (not available in the United States), progesterone, cimetidine (Tagamet), and multiple non-prescription and herbal products. A full discussion of approved and unapproved treatments for AGA can be found elsewhere.6,7 In all forms of alopecia, hairpieces and surgical transplants can produce satisfactory results but are expensive.

Because of its psychologic nature, the mainstays of treatment are counseling, behavior modification techniques, and hypnosis. Selective serotonin reuptake inhibitors and other medications for depression or obsessive-compulsive disorder may be used in some cases, although no medications are FDA-approved for treatment of trichotillomania.17 If a more moth-eaten appearance of hair loss is present and no evidence of hair-pulling behavior can be elicited, syphilis should be suspected.


Ironically, taking the hormone levothyroxine to treat an underactive thyroid can contribute to some hair loss, among other side effects, but this seems to be more common within the first month of treatment and more often in children than adults. This hair loss is only temporary and will go away as treatment is continued and thyroid hormone levels stabilize.


Eva if you can look at some of Pilar’s post she mentions in one of them a dr she sees in NYC. She loves her and the dr has done a lot for her. I would say there is no doubt it is the Retin A that has caused your loss, but it is probably Telogen Efflivium which is temporary and the recovery is nothing like they say it is. Especially if your scalp is miserable because there is a lot of inflammation that will need to calm down before everything can reset itself. Please try to find her post where she list the derm she sees. She loves her.

A separate study, published in Skin Therapy Letter — a professional reference site for dermatologists — found that women also benefit from using the more potent 5 percent minoxidil treatment. “Patient-reported improvement in hair volume and coverage appears to be greater with 5 percent minoxidil foam,” reads the report. Plus, because the 5 percent treatment is stronger, women only have to apply it once a day to get the same results as they would with the 2 percent treatment applied twice daily.


Telogen effluvium occurs when the normal balance of hairs in growth and rest phases is disrupted, and the telogen phase predominates. The disproportionate shedding leads to a decrease in the total number of hairs. Axillary and pubic areas often are involved, as well as the scalp.2 The hair-pluck test usually shows that up to 50 percent of hairs are in the telogen phase (in contrast to the normal 10 to 15 percent), although these results can vary in persons with advanced disease.4  The patient often is found to have had inciting events in the three to four months before the hair loss (Table 4).1,4 If 70 to 80 percent of hairs are in the telogen phase, the physician should look for causes of severe metabolic derangements, toxic exposures, or chemotherapy.1,4 No specific treatment for hair loss is required because normal hair regrowth usually occurs with time and resolution of underlying causes. Lack of significant historical events and a delay in regrowth should raise suspicion for syphilitic alopecia.1
Interesting reading all the stories, I had great hair until 15 years ago,and then the texture of my hair drastically changed. It be became “dead hair” wirery. I call it it my chicken feathers just taking its time to fall out which it has done over a long period of time, but I now have bald spots on the sides and thinning in my bangs. I started buying wigs years ago knowing that this was something that was inevitable. I’ve had all the tests and tried all the products, nothing..just curious if anyone else has had the “dead hair” issue
Men, oh yeah, different ball game. Just think how much money is spent on prostate research and medication versus female cancers!!!!! This IS a male society, but just smile, that makes you feel better. Do not let this get under your skin. KNOW who you are with or without hair, you are one fabulous person, loving and shining your light on this world. Step into that, claim it, own it. Whoever is unkind to you, just love them, bless them and wish them well. They have a bigger problem than you, trust me. And the WILL bump into it one day and not know what hit them.
Today, one of the most common problems that could degrade one's beauty is hair loss. Most individuals usually shed 50 to 100 hairs every day. This loss, usually does not cause noticeable thinning of scalp hair, as new hair simultaneously grows along. Hair loss occurs when this cycle of growth of hair and shedding of hair is disrupted or when the hair follicle is destroyed and replaced with scar tissue. There are a lot of causes of hair loss. Usually hair loss could be heredity or because of family history, can be due to hormonal changes, because of certain medications and also because of some medical conditions or diseases. Several conditions or diseases leads to hair loss. If you are one of those who suffer from loss of hair then you would probably love to read this article which explains about the diseases that cause hair loss.
I have Alopecia Areata, Hoshimoto Thyroiditus, both are autoimmune diseases. I also now am losing hair all over my head. I have itching, redness, pustules and think it may be Cicatricial Alopecia (Scaring Alopecia). I have tried Biotin 10,000mcg per day for 3 yrs didn’t work, also Nioxin didn’t work. Minoxidil 5% worked the first time I lost some hair but not anymore. I have been given oils, creams, and still no luck.I went to a Derm and he didn’t seem to care. I am embarrassed to go out becauseyoou can really see my scalp through my very thin hair. I use to have very thick hair but that is gone. I can’t afford a wig and don’t know where to turn now. I have to support where I live (Rialto, Calif.). Any Ideas?

“The most common cause of hair loss in both men and women is androgenetic alopecia, which is genetic pattern hair loss,” explains Dr. Michael B. Wolfeld, a board-certified plastic surgeon and an assistant clinical professor of plastic surgery at the Icahn School of Medicine at Mount Sinai Hospital in New York. The root cause of this type of hair loss is dihydrotestosterone (DHT), a byproduct of testosterone that shrinks certain hair follicles until they eventually stop producing hair.
Each hair develops from a follicle — a narrow pocket in the skin — and goes through three phases of growth. Anagen (A), the active growth phase, lasts two to seven years. Catagen (), the transition phase, lasts about two weeks. During this phase, the hair shaft moves upward toward the skin's surface, and the dermal papilla (the structure that nourishes cells that give rise to hair) begins to separate from the follicle. Telogen (C), the resting phase, lasts around three months and culminates in the shedding of the hair shaft.
I”m sitting here reading all your letters hoping that you’ve helped someone and hoping that you can help me, too. I’m 48 and all my life I’ve been told how beautiful my hair was. I now live in S Florida and within the last couple of years I stopped styling my hair because of the heat and the humidity. I usually wear it in a ponytail (never tight – I’m sure that’s not the problem). About a year ago I noticed athat a lot of hair was on the back of my car seat.I mean A LOT.When I went home to NY I tried to style my hair like I used to and it didn’t work. It just layed there.The more I looked I noticed how thin it was. I came back to Fl and went to a dermatologist who barely looked at me and told me to try rogaine.
The dermatologist also will carefully look at your scalp and hair. During an exam, the dermatologist may pull on your hair. Sometimes a dermatologist needs to pull out a hair to get the necessary evidence. And sometimes a dermatologist needs to look at the hair on the rest of your body to see whether there is too little or too much hair in other areas.
In addition to diagnosing and treating any underlying disorder, treatments for alopecia areata include immunomodulating agents and biologic response modifiers (Table 5).6 Although topical and oral corticosteroids have been used, the treatment of choice in patients older than 10 years with patchy alopecia areata affecting less than 50 percent of the scalp is intralesional corticosteroid injections (Figure 8).6
Some other autoimmune diseases can also lead to hair loss. Lupus, which affects many different systems of the body, is one of them. Symptoms include fatigue, headache, painful joints, anemia, abnormal blood clotting, and hair loss, according to the website LiveStrong. The disease is usually triggered by environmental factors like exposure to the sun. Hashimoto’s disease, which occurs when the immune system attacks the thyroid gland causing an underactive thyroid, can also result in hair loss.
Once male-pattern baldness starts, it’s not going to stop until every last hair on your head has shrunk or shed, though the rate at which this happens differs from person to person and depends on genetics. And since the grind of hair loss is unending, it’s important to start treatment as soon as your hairline starts bothering you. If you’re looking for a more quantitative metric, Dr. Paul McAndrews, clinical professor of dermatology at the USC School of Medicine and member of the International Society of Hair Restoration Surgery, assures me that “you have to lose half your hair before the human eye can tell.” (Of course, if you don’t care about losing your hair and are fine with going full Prince William and shaving your head, go for it. We’ve got some recommendations for razors and hair trimmers to help you out on that front.)
Susan – I am horrified to read that two of your doctors actually made fun of you… oh my gosh that is awful! I’m so sorry you had to go through that. I am also surprised that your doctors wouldn’t do any bloodwork other than thyroid. What City/ State do you live in? Maybe someone can recommend a doctor in your area that would be more helpful. While many times bloodwork results end up coming back normal there is that possibility that your results would point to something that may be the cause of your hair loss, especially since you say you have no genetic hereditary hair loss in your family. I know you stated your hair is still falling out, but do you see any results from the propecia and mens rogaine? When did your hair loss start?

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Current evidence suggests that alopecia areata is caused by an abnormality in the immune system that damages hair follicles. This particular abnormality leads to autoimmunity, a misguided immune system that tends to attack its own body. As a result, the immune system attacks particular tissues of the body. In alopecia areata, for unknown reasons, the body's own immune system attacks the hair follicles and disrupts normal hair formation. Biopsies of affected skin show immune lymphocytes penetrating into the hair bulb of the hair follicles. Alopecia areata is occasionally associated with other autoimmune conditions such as thyroid disease, vitiligo, lupus, rheumatoid arthritis, and ulcerative colitis. The diagnosis or treatment of these diseases is unlikely to affect the course of alopecia areata. Sometimes, alopecia areata occurs within family members, suggesting a role of genes.
Physical stress can also be a cause for hair loss. Any kind of physical trauma surgery, a severe illness, an accident, even the flu can lead to temporary hair loss. This can trigger a type of hair loss known as Telogen effluvium. Hair loss usually gets noticeable 3-6 months after the trauma but once your body recovers, your hair would start growing back again.
I was searching the internet and came across this wonderful site. I really appreciate you posting this article. I have always had a small bald patch on one side of my head. My mom told me it had always been there so I didn’t worry about it. Recently it has been getting larger and the hair around it is getting lighter. On the other side my hair is thinning and the color and texture is changing. It also seems to be falling out. I have excessive hair loss on a regular basis. I am only 24 years old and I can’t stand that my hair is falling out. I went to the dermatologist and he gave my injections but they didn’t work. He said I have alopecia areata and that the other side was a normal receding hairline. (He barely even looked at it) He then told me after the injections weren’t working to try Rogaine. I think it might be helpful to see an endrocrinologist as I have also been having problems with anemia. Again, thank you so much for the information you have provided.
Hi, I’m 25 years old, and started having hair loss at 15. It started and has continued to thin around my hairline only on one side, to the point that one side is receded and extremely thin. About a year and a half ago, my overall scalp started thinning as well. It’s been about a year since I’ve dyed my hair and I rarely ever put hairspray or any other chemical in my hair. I try to just wash it and let it air dry in fear that anything I do will make more hair fall out. I haven’t been to a doctor at all so far because I’ve never had health insurance. I’m about to have insurance next month and will be looking for a doctor to go to ASAP. I’ve been trying to look online and see what information I can find about what’s happening with me, but I dont’ see anything about a similar case to mine. I used to have long, thick hair and could do anything with it, and now it’s short and thin, and I can never style it at all, and my receding hairline on my right side has me so self conscious. I live in Baton Rouge, Louisiana, does anyone have any suggestions to my situation or a reputable doctor in this area?
Harklinikken (“hair clinic” in Danish) inspires great loyalty. Four out of five users come as referrals from satisfied customers, said Lars Skjoth, the company’s founder and chief scientist. The results are certainly compelling. After four months of daily application — that is, working the tea-colored tonic into the hair section by section, then letting it sit on the scalp for six hours — most users regain at least 30 percent of lost density, and some as much as 60 percent, according to company figures.
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